Once again, a major news source has published a high profile article about the utility of analyzing spinal fluid as a means of diagnosing neurological disorders like Alzheimer's disease. Today, it is this article in the LA Times.

While a great many of these articles waver unconscionably between the concepts of prediction and diagnosis, the LA Times article has taken a more responsible look at the full utility of spinal fluid as a bio-marker for many diseases. They present a balanced overview of how bio-markers may be used to better understand disease, to gauge severity and progression of disease, and to better measure treatment effects. In my opinion, this is an example of good journalism.

Less good are the recent (and more prevalent) articles that refer to recent research demonstrating the accuracy of a spinal fluid assay for diagnosing Alzheimer's, but then write sensationally about the ethical dilemma inherent in using the assay as a predictor for an incurable disease. While I concede that there are some valid downsides to predicting this incurable disease, it is a shame to overlook the value of the spinal assay as a pure diagnostic tool.

When a patient experiences cognitive difficulties and they seek a doctors opinion about the cause, it is very beneficial that physicians may now have an accurate spinal fluid test that can help them confirm, or rule out, the presence of Alzheimer's pathology.

--------------------------------------------------------------------------------A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

Regular readers of this blog have undoubtedly seen the evidence that physical exercise is good for the brain. Most of the research in this area is based on benefits associated with improved cardio-vascular health and a more consistent, oxygen-rich supply of blood to the brain.

Now, according to research from the Beckman Institute at the University of Illinois, published online in Frontiers in Aging Neuroscience, it appears that certain neurological mechanisms also play a role in translating physical exercise into better brain health.

This research recruited a group of sedentary adults aged 59 to 80 and assigned them to one of two groups. Members of the first group walked for 40 minutes at their own pace, three times per week, for one year. Members of the other group did stretching and toning exercises with similar frequency and intensity during the same period. Cognition was measured in each of the two groups at the start, mid-point, and conclusion of the study.

As expected, the walking group demonstrated significant improvements from their baseline scores. They also showed much greater improvement than those in the stretching and toning group.

The researchers were also seeking to demonstrate any neurological benefits, in addition to the expected vascular benefits provided by the exercise. To accomplish this, they used MRI to measure activity across circuits in the subject's brains. They noted an interesting finding with regard to the default mode network (DMN) which is the circuit in the brain that is most active when the brain is at rest and relatively unengaged in other activities.

In healthy brains, the DMN quickly deactivates when the person engages in a task that requires their concentration. However, in older and/or sicker brains, the DMN tends to stay active and interferes with one's attempt to focus on a more challenging task. In this study, the subjects who walked for a year showed a significantly better ability to deactivate the DMN and focus on other tasks. This was true compared to the stretching and toning group but also true compared to their own performances at the start of the study.

This is great news on two levels. We already knew that physical exercise was beneficial to both our physical and mental health. Now it seems that a light work-out, as simple as walking at one's own pace for 40 minutes per walk, three times per week, is adequate to produce a meaningful benefit. Furthermore, the benefit is derived from two distinct mechanisms, one physical and the other neurological.

--------------------------------------------------------------------------------A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

The expert consensus on this is growing stronger every day: we are intervening against Alzheimer's disease far too late.

This perspective has been long acknowledged in clinical circles, where physicians first treat Alzheimer's patients an average of about 8 years after the onset of subtle symptoms. But recently, it has gained rapid momentum in research circles as well.

With the recent, high-profile failure of another AD drug in the FDA pipeline, the research community is increasingly concluding that, the inefficacy of the drugs may be due, in part, to the fact that we are testing them on patients in whom the disease is too advanced. It does stand to reason that, once a brain cell is dead, no drug will bring it back to life.

As reported by The Telegraph, an editorial in this months issue of The Lancet summarizes this emerging viewpoint with clarity.

--------------------------------------------------------------------------------A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

This is a re-run of a post from last August but the message is still relevant.

Each fall, the National Alzheimer's Association helps to coordinate hundreds of local Memory Walks in the nation's communities. These walks raise funds for ongoing research and support programs and do a great deal to raise awareness of the growing prevalence of Alzheimer's disease.

I encourage each and every reader of this blog to consider participating in a memory walk this year. Aside from the obvious benefits of participating in such a good cause, they are extremely inspiring events with many participants walking in the memory of a loved one. The atmosphere is always charged with emotion and touching tributes.

Also, because one of the biggest barriers to better care in this field is late detection of the problem, we really need to start lifting the stigma that prevents many people from seeking care when their symptoms are very subtle. These memory walks are fantastic vehicles for destroying that stigma. Nearly every person in the crowd will have cared for a loved one with the disease or lost a loved one to the disease. There are also a fair number of Alzheimer's patients who participate and advocate for greater visibility.

Overall, I am a strong supporter of the memory walk events and feel that they bring more than just important funds to this problem. They bring visibility and education to a growing number of citizens each year and I hope each of you will consider participating and contributing to one of these programs this year.

--------------------------------------------------------------------------------A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

Sometimes, a debate is framed in such a way that important perspectives are under-emphasized if not completely overlooked. I think this is the case in the spirited debate about if and when we should use biomarkers to help diagnose Alzheimer's disease.

I can understand that many young, healthy people would prefer not to know that Alzheimer's lurks with certainty in their future. That whole discussion is important but perhaps off-point. Here is what we should not overlook.

An increasing number of people are expressing memory complaints to physicians on a daily basis. Some are depressed, some have early stage AD, some have had a small stroke, some have a thyroid disorder, and among the others, many are perfectly healthy but correctly perceiving changes associated with their advancing age. It is the physician's job to accurately diagnose any underlying medical conditions and to treat them. In these cases, an accurate test for Alzheimer's disease has great value.

The published research in this area is clear. A great many AD patients go undiagnosed and untreated for many, destructive years as their doctors grapple with an uncertain diagnosis. Others are treated for Alzheimer's disease based on an educated guess, when in fact their true condition could have been more effectively (and perhaps less expensively) treated had the diagnosis been correct.

I do not suggest that we run out and test people with no symptoms of cognitive decline. I do suggest that a great many patients and their doctors will benefit enormously when a commercially viable diagnostic test for AD is available.--------------------------------------------------------------------------------A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

Is there a relationship between retirement and Alzheimer's disease? Sure, they both tend to happen later in life, but is there a deeper connection?

The answer to this question is not known with any certainty. However, there is growing evidence that keeping your mind actively engaged in purposeful activities may reduce the risk of cognitive decline. A meaningful job, or at least an occupation that one strives to do well, provides a structure for such constant, mental engagement.

It is plausible that the removal of such structure, through retirement at a socially anticipated age in the mid to late sixties, could have a significant impact on the cognitive wellness of an entire population. If so, actively developing a new perspective on how we view retirement and the relative merits of the "easy life", might be an excellent avenue for improving the health of our aging nation.

An excellent discussion of this topic, including the informed opinions of Dr. Jeffrey Cummings, Director of the Cleveland Clinic Lou Ruvo Center for Brain Health, was published last week in the Las Vegas Review Journal.--------------------------------------------------------------------------------A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

Contributed by: Michael Rafii, M.D., Ph.D - Director of the Memory Disorders Clinic at the University of California, San Diego. ______________________________________

Despite the recent stoppage of the semagacestat trial and the negative findings from the Dimebon study, there still remains a frenzy of activity searching for a disease modifying drug for AD. There are currently three large phase III trials being conducted for mild-to-moderate AD, and more about to get underway:

Bapineuzumab:Bapineuzumab is a humanized, monoclonal, anti–beta-amyloid antibody. It is designed to bind to and remove the beta-amyloid peptide that accumulates in the brains of those with Alzheimer’s. This study uses an approach called “passive immunization” in which subjects are immunized with antibodies to beta-amyloid.

IVIg:On the market for more than 25 years as a treatment for autoimmune diseases, IVIg contains antibodies that bind to the beta-amyloid aggregates many believe are central to cognitive decline of Alzheimer’s.

Solanezumab (LY-2062430):Solanezumab is a beta-amyloid antibody designed to bind to and remove the beta-amyloid protein that accumulates in the brains of those with Alzheimer’s. More specifically, it binds to soluble beta-amyloid and may pull the beta-amyloid away from the brain to be cleared through the blood.

In addition, a Phase III trial of Resveretrol in mild-to-moderate AD will soon begin. Resveratrol is a compound in grapes and wine. While levels of resveratrol in wine varies, it is generally more abundant in red grapes and red wine. Resveratrol intake has demonstrated in vivo protective properties against multiple illnesses, including cancer, cardiovascular disease, and ischemia, and was also found to confer resistance to stress and to extend life span. It has been demonstrated in small studies to have some positive effects in AD. Resveratrol has been shown to lower the levels of secreted and intracellular amyloid-beta (Abeta) peptides produced from different cell lines by promoting intracellular degradation of Abeta. It has been shown to promote neuronal survival.

To sum up, beta-amyloid is still the target for most Alzheimer's therapies. We are learning that soluble beta-amyloid, not amyloid plaque, is most likely causing brain cell destruction. I think each trial has a very good chance of showing some benefit. Namely, in each of these trials (perhaps with the exception of resveretrol), soluble amyloid is the target, and the immune system is being used to target beta-amyloid. The big question is whether treatment is initiated early enough in the course of the disease to limit how much damage soluble beta-amyloid is causing.

--------------------------------------------------------------------------------A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.

For some time now, the leading explanation of Alzheimer's disease has been an abnormal accumulation of beta-amyloid in the brain, which leads to cell death and impaired mental function.

While the amyloid hypothesis has been the leading explanation, it has not been universally accepted and is only one of several possible explanations of Alzheimer's pathology. Each time results are released from an FDA trial, researchers scramble to reconcile the results with what is known about treatment targets and the underlying mechanisms of disease progression.

Yesterday's announcement by Eli Lilly that they were canceling development of an agent formulate on the the amyloid hypothesis has reignited discussions about the cause of Alzheimer's disease. A very thorough summary, with cogent, expert commentary from both supporters and detractors, was published today by Bloomberg. This short article provides a balanced view of where the research community stands on the amyloid hypothesis.--------------------------------------------------------------------------------A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

By Michael Rafii, MD, PhDUniversity of California, San Diego___________________________

Eli Lilly and Company announced yesterday that it is halting development of semagacestat, a γ-secretase inhibitor being studied as a potential treatment for Alzheimer's disease. The decision was made after preliminary results from two separate phase 3 studies showed that the drug did not slow disease progression and worsened cognition and the ability to perform activities of daily living.

In the 2 trials, called IDENTITY (Interrupting Alzheimer's Dementia by EvaluatiNg Treatment of AmyloId PaThologY) and IDENTITY-2, semagacestat was compared with placebo in more than 2600 patients with mild-to-moderate Alzheimer's disease. Endpoints for the trials were the Alzheimer's Disease Assessment Scale–Cognitive subscore and the Alzheimer's Disease Cooperative Study–Activities of Daily Living Inventory.

Analysis showed that cognition and the ability to complete activities of daily living worsened in placebo-treated patients, as expected. However, by these same measures, patients treated with semagacestat worsened to a statistically significantly greater degree than those treated with placebo. In addition, semagacestat was associated with an increased risk of skin cancer compared with placebo.

What does this mean for the Amyloid Hypothesis? And what does it mean for clinical trials of AD drugs?

I think the amyloid theory is still valid, but this clearly tells us that our current views may be too simple—clearing amyloid at the stage of mild-to-moderate AD may have little, if any impact on cognition. It must be kept in mind that amyloid deposition in the brain occurs over decades. By the time synapses are lost, administering a drug that decreases beta-amyloid may be too little, too late. In fact, if hippocampal atrophy is present, then there is clearly loss of brain tissue and amyloid had already done its damage.

I think a good analogy for AD is that of heart disease. If a patient presents with a heart attack, starting them on a cholesterol lowering drug will have little impact on their symptoms from the heart attack. But, if the cholesterol levels are checked 5 or even 10 years prior, then a cholesterol lowering drug would certainly reduce the risk of having a heart attack in the first place. By measuring beta-amyloid levels in the brain and cerebrospinal fluid, measuring hippocampal atrophy and trying to identify AD in its earliest stages, we will allow these drugs to have their greatest impact.

--------------------------------------------------------------------------------A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.

One of Eli Lilly's late-stage Alzheimer's drugs, the gamma-secretase inhibitor Semagacestat, has failed its Phase III FDA trial and the company has halted its development. This announcement today was somewhat expected by the research community as other gamma-secretase inhibitors, namely Flurizan (Myriad Genetics), had also been deemed ineffective in a large trial.

While this is disappointing news, the overall trend of scientific progress in the field of Alzheimer's is clearly positive. New guidelines have been proposed that will facilitate earlier intervention and better treatment results. New diagnostic tests are showing greater accuracy and bode well for more certainty in clinical practice. And perhaps most importantly, the pipeline of treatments under development is full of promising agents.

An updated summary of the current FDA pipeline for Alzheimer's treatments will be posted here later in the week.

--------------------------------------------------------------------------------A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.

The relationship between heart health and brain health is gaining much needed understanding and, thankfully, growing public awareness.

It only makes sense that a steady flow of oxygen rich blood to the brain will provide the necessary conditions for optimal brain health. As such, it is not surprising that a new study, published in Circulation, showed a correlation between "cardiac index" and "brain size".

Cardiac index is a measure of how efficiently the heart pumps blood through the body and brain size is known to correlate with cognitive decline and dementia. The suggestion of the research is that we don't necessarily need to wait and see all the necessary steps of a logical progression from poor blood flow to vascular disease to brain disease to declining cognition. Perhaps we can use poor blood flow to predict oncoming issues with brain health which might serve as another important motivation to maintain good cardio-vascular health.

This description of the study in the USA Today, along with accompanying expert testimony is well written. It balances the optimistic scientific advance with the reality about how much more work is necessary to understand the relationship between cardiac index and brain health. It looks promising but it is still too early to make clinical decisions based on what we know.--------------------------------------------------------------------------------A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

With the growing awareness of Alzheimer's disease, it is understandable that many people are concerned about perceived declines in their ability to store and retrieve information.

The most beneficial message from a public health point of view must strike a careful balance. While it is not helpful to worry needlessly about every failure of recall, it is potentially disastrous to ignore obvious warning signs of advancing illness.

An article published yesterday in the USA Today makes a point that we emphasize often in this blog. Namely, not all forgetfulness is the same and much of it is not necessarily worrisome. Knowing the difference between benign memory lapses and potentially serious memory lapses is important.

Types of Memory
Scientists classify memory into three categories as described below:

Working Memory - this is often called "attention span" and it refers to the information you can hold in your consciousness without storing for later retrieval. For example, a phone number that you hear on the radio and dial one time before forgetting. This function is located in the frontal lobe of the brain.

Short-Term Memory - these are the things you will remember for a few minutes and up to a couple of weeks. Examples are the room number of your hotel on vacation or the character's names in the book you just finished. This function is located in a brain area called the hippocampus.

Long Term Memory - these are things you might recall forever such as your date of birth, your favorite teacher from grade school, or the name of your first pet. Storage of long-term memory is not well understood in terms of which parts of the brain are involved.

In terms of understanding one's own memory and possible signs of Alzheimer's disease, short-term memory is very important. This is because the pathology we associate with Alzheimer's disease generally begins in the hippocampus where short-term memory is processed. Therefore, lapses in short-term memory are the most worrisome.

On the other hand, it is very normal to notice a reduced capacity for working memory which declines linearly, although not drastically, with age. As noted in the USA Todayarticle, stress, distraction, and multi-tasking all interfere with working memory and, coupled with the aging process, lead to all sorts of benign lapses such as lost keys and truncated trains of thought.

It is great to monitor your memory and to be vigilant about troubling signs of memory loss but it is also good to be aware of how your memory works and why you sometimes seem more forgetful than you really are.--------------------------------------------------------------------------------A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

Researchers have devised what seems to be a highly accurate test to identify the signature proteins of Alzheimer's disease in spinal fluid. In a publication about the test in this month's Archives of Neurology, the test showed perfect accuracy in patients known to have Alzheimer's disease.

One particular application of this technology could have great clinical utility. When aging patients present to their physician with memory loss, the physician must consider many possible causes of the problem before prescribing treatment. In some instances, the physician can find an obvious culprit such as stroke, depression, or a number of metabolic conditions. In other instances, the diagnosis is less clear. This new test might add much needed clarity to the diagnostic process for identifying Alzheimer's disease. This will help get AD patients on proper treatment in a timely manner while preventing others, who might otherwise be misdiagnosed with AD, from receiving wrong treatment.

Some more difficult questions about the value of this new test have arisen from the fact that, in the study, the test showed that about one third of subjects who had no symptoms of memory loss, also had the signature proteins in their spinal fluid. One interpretation is that these subjects have early stage pathology and will eventually develop the symptoms. This has given rise to the dilemma: Who should get tested and what should we do with those who test positive?

I would argue that this question, which is framed in terms of the entire population, poses no dilemma at all if you frame it at the individual level. Those who wish to inform themselves about risks in their future, so as to prepare themselves legally, financially, and spiritually, as well as to engage in life style modifications that could prolong health, should be free to have a test and learn what they can. Those who prefer not to know should be allowed that option as well. There are compelling arguments on either side.

As our understanding of the disease and our ability to treat it improve, the "find out early" side of the argument will be generally adopted by the masses and no debate will remain. In the meantime, there is no need to persuade everyone to accept one approach or the other. Those who prefer information should have access to it, while those who prefer ignorance should be allowed their bliss.

In a well-written summary of the ethical questions surrounding this science, bio-ethicist Jonathan D. Moreno commented on this development in The New Republic.--------------------------------------------------------------------------------A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

For some years now, the research community has been intensively investigating bio-markers to help diagnose Alzheimer's disease at an early stage while the symptoms are still subtle and minimal brain damage has occurred. It is hoped that bio-markers progressing in advance of symptom progression will also be useful in understanding the disease and in unlocking the secrets of effective treatment.

There is massive press this week (NYTimes, CNN, WebMD, LATimes) on a new study published in the Archives of Neurology. The study shows that protein levels in the spinal fluid are useful in diagnosing Alzheimer's disease, even in subjects with mild memory deficits that would not meet today's criteria for a diagnosis of Alzheimer's disease. This is good news and bodes well for ongoing efforts to understand and treat this debilitating disease.

Interestingly, this finding also adds importance to another debate that has been recently prominent in the press. The debate concerns the utility of new proposed guidelines that would define Alzheimer's disease based on the presence of mild symptoms plus pathology as opposed to the current guidelines which require severe symptoms (dementia) before making the diagnosis. What began as a hypothetical (if we had a good bio-marker, would we consider subtle memory loss plus a positive indication from the bio-marker as a conclusive indication of AD?) has now become a more concrete and more urgent question.

Personally, I side with the growing consensus of experts who believe that memory loss, when coupled with a bio-marker known to be associated with AD (hippocampal atrophy, amyloid plaques, or now, signature proteins in the spinal fluid), should be diagnosed as Alzheimer's disease and treated accordingly if other common causes of memory loss (depression, thyroid, vitamin deficiency, etc.) have been ruled out.--------------------------------------------------------------------------------A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

It has been a long time coming but the the press and the general public are finally beginning to grasp the benefits of detecting Alzheimer's disease at an early stage.

A publication this week in the Archives of Neurology described a highly accurate test of spinal fluid for definitively diagnosing the pathology we associate with Alzheimer's disease. While the debate about "when the disease begins" will continue to rage (does it begin at the onset of definitive pathology or at the onset of symptoms?), a consensus has emerged that earlier detection is better.

Regular readers of this blog know that I am often flabbergasted at what I consider to be negative interpretations of scientific advance, superficial skepticism about progress, and nihilism with regards to our overall ability to combat dementia in an aging population. However, the press this week around this new diagnostic approach has been very positive.

As a case in point, this brief editorial posted today in the New York Times makes a cogent argument supporting early detection and diagnosis of Alzheimer's disease. While many cling to the outdated dogma that, until a cure is found, it is better "not to know", recent scientific advances and some progressive thinking are ushering in a new paradigm.--------------------------------------------------------------------------------A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.

The press is currently overflowing with coverage of the proposed changes to the outdated guidelines for diagnosing Alzheimer's disease. Most of the articles I have read have taken a sensationalistic and misleading slant. It may be superficially interesting to emphasize that early identification of AD will benefit drug makers, but that should not overshadow the real clinical benefit of earlier intervention.

Facts in a Nutshell
Current guidelines dictate that a person who consults a physician and complains of memory loss does not have AD until they become demented. Physicians can look for other causes of memory loss, such as depression, stroke, or thyroid disorder, and treat any problems they find. However, if nothing is found, and AD is strongly suspected, the guidelines prevent an actual diagnosis and treatment until the patient's symptoms progress to the dementia stage. The new guidelines would allow physicians to identify the disease at an earlier, and perhaps more treatable, stage of progression.

This point, that our current practice of late diagnosis is partially driven by outdated diagnostic standards, is highlighted in a report today from the Medical Research Council in the UK. This report clearly shows that primary care physicians are waiting too long to diagnose dementing illnesses and therefore, not treating them optimally.

I understand the mistrust of big pharma; they've earned their reputation. But I also understand that the effort to contain the growing Alzheimer's problem will absolutely enrich those with a piece of the solution. Don't forget that it will also diminish returns for those who currently profit from caring for demented patients.

Alzheimer's disease starts with a long slow period of accumulating pathology that is still not well understood. The current practice of waiting for clear symptoms before diagnosing and treating the disease has proven disastrous because too much brain damage occurs prior to the emergence of definitive clinical signs.

Merely recognizing that the disease is underway prior to full-blown dementia is not a greedy plot underwritten by the pharmaceutical and imaging industries; it is a scientifically sound approach to improving care in this field. It will enable more timely intervention and a clearer understanding of treatment efficacy with currently approved approaches.

Yes, we need to understand the pathology better and yes, we need new treatments that stop or slow disease progression; but we will never get those if we don't look at the disease clearly. Adhering to the current guidelines that deny the presence of AD prior to the patient becoming demented is a barrier to progress.

This is a common question that needs to be recast before it can be answered in any useful way.

To explore the question as posed, we must start with this other question: What is the cause of the Memory Loss you wish to treat? Once we have that information at hand, we can properly respond.

The point of this post, and of this recent article from KABC-TV in Los Angeles, is that there are many medical conditions that can cause memory loss. While many seem people to be most acutely aware of Alzheimer's disease, other common conditions such as depression, thyroid disorders, and vitamin deficiency can also impair memory.

In terms of treatment efficacy, these latter three (depression, thyroid, and vitamin deficiency) can be treated with excellent results. Alzheimer's disease treatments are less effective but perhaps not as poor as many headlines would indicate. The key to delaying progressive symptoms of Alzheimer's is early intervention coupled with a robust treatment plan that includes prescription drugs but also emphasizes good nutrition, physical exercise, social engagement, and careful management of other conditions such as diabetes and hypertension.

Not every patient responds well to this treatment but many can delay progression of decline due to Alzheimer's disease for a meaningful period of years. As such, the simple answer to the question "Is Memory Loss Treatable?" must be "Yes". The degree of treatment success depends on the cause of the memory loss and individual factors related to the patient's health and genetics.

As we write here often, late diagnosis is the key barrier to better treatment of Alzheimer's disease.

We routinely identify the disease after about 7 years of symptoms when irreversible brain damage has already occurred. Earlier intervention, even with today's modestly effective drugs, would be more beneficial if started earlier and combined with improved diet, regular physical exercise, and careful management of other medical conditions such as hypertension and diabetes.

One reason we have historically been slow to diagnose Alzheimer's is that the guidelines for making such a diagnosis included "dementia". That is to say, until the disease process has diminished a person's thinking capacity to a point where they can np longer function independently, they don't yet have Alzheimer's disease.

The proposed changes to the guidelines suggest that the disease is indeed present, and should indeed be treated, prior to the patient becoming so mentally debilitated. This makes great sense and I see the proposed changes as a winning strategy in the battle against this terrible illness.